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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624040
Report Date: 11/30/2022
Date Signed: 11/30/2022 03:56:47 PM

Document Has Been Signed on 11/30/2022 03:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SACRAMENTO WALDORF SCHOOL EARLY CHILDHOODFACILITY NUMBER:
343624040
ADMINISTRATOR:MACK, ASHLEYFACILITY TYPE:
850
ADDRESS:3750 BANNISTER RDTELEPHONE:
(916) 961-3900
CITY:FAIR OAKSSTATE: CAZIP CODE:
95628
CAPACITY: 15TOTAL ENROLLED CHILDREN: 15CENSUS: 2DATE:
11/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Rozzlyn SovereignTIME COMPLETED:
03:29 PM
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On November 30, 2022 Licensing Program Analyst (LPA) Lea Habtom met with staff member Rozzlyn Sovereign for an unannounced case management visit. The purpose of today's inspection is to clear the deficiency cited on October 26, 2022 relating to medication storage and paper work accompanying the medication from the authorized representative. LPA L. Habtom confirmed that staff are aware that medication must be stored in an area that is inaccessible to children. Staff member notified LPA L. Habtom that the child is no longer enrolled and there are no children currently on medication. Staff are aware that medication must have an unaltered label and the authorized representative must give written approval to administer the medication which should be kept in the child's file.

No Title 22 citations were issued during today's inspection.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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